| NPI | 1518912807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 17498) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 17498) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2008-07-09 |